March 17, 2010
Volume 12, Issue 6
Midwifery Today E-News
“Nutrition”
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Cook delicious and wholesome meals for your whole family

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Whole Family Recipes—For the Childbearing Year & Beyond highlights foods that are especially needed by pregnant women, breastfeeding mothers, and their growing children. Taking a non-dogmatic and down-to-earth tone, the book focuses on incorporating vitamin- and mineral-rich foods and good quality fats into the diet.

If you're an expectant mom or new parent this book belongs in your kitchen. If you work with pregnant women, have copies in your library to share with your clients. Recipes include Cheesy Potato Pie, Baked Lentils and Oat and Dried Berry Bars. To order


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Midwifery Today Conferences

Plan now to attend our conference in Philadelphia, April 2010

You'll find classes for seasoned midwives, childbirth educators, doulas and activists, and for those aspiring or just beginning to work in the birth field. Come to the conference to expand your knowledge and your network and to renew and rejuvenate your heart. Planned teachers include Ina May Gaskin, Marsden Wagner, Michel Odent and Elizabeth Davis.

Learn more about the Philly 2010 conference and get a complete program.


Ina May Gaskin ~ Elizabeth Davis ~ Michel Odent

Learn about birth from these great teachers when you attend our conference in Strasbourg, France, September 29 – October 3, 2010. Planned classes include Prolonged Pregnancy, Prolonged Labor, Managing Hemorrhage, Posterior Position and Preventing and Managing Birth Complications at Home.

The complete program for the Strasbourg, France, conference this fall is now online! You may view it online or download a PDF. Sign up for your first choice of classes before they fill up!

Learn more about the Strasbourg conference here.


Come to Moscow! Learn about birth!

Plan now to attend the “Birthing in Love: Everyone’s Right” conference this June in Moscow, Russia. You'll be able to choose from classes such as Russian Method of Waterbirth, Traditional Birth Practices from Russia, Midwifery Education Possibilities for Russia, The First Hour after Birth, and Prolonged Labor. There will also be a full-day Hands-on Skills Workshop, as well as full-day classes on Shoulder Dystocia, Breech Birth in Water and Improving Your Practice with Research, Insights and Realities.

Learn more about the Russia conference and view complete program.

In This Week’s Issue:


Quote of the Week

“When a woman comes under your care, assume she's undernourished. The majority of women have no idea that diet is important, even today.”

Dr. Tom Brewer


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The Art of Midwifery

I encourage all my clients to drink 16–32 ounces of nettles tea each day. For women who just cannot drink this tea, or drink it in that quantity, I suggest taking the herb in capsule form (two capsules, three times a day).

Nettles tea is a superior natural thirst quencher, high in Vitamin K, iron and important anti-oxidants. Mixed with other woman-friendly herbs such as oat straw, red raspberry leaf and red clover, these herbs support the expanding blood volume and tone the uterus. It is a wonderful and refreshing beverage hot or cold. Taken during labor, it provides all important, blood clotting Vitamin K for mother and baby. After the baby comes, it continues to refresh the mother, and helps increase milk production.

Kim Mosny, CPM
Excerpted from Midwifery Today's Tricks of the Trade, Vol. III
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ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


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Jan’s Corner: Healing after a Traumatic Birth?

Is healing after a traumatic birth really possible? Please tell me if you have actually healed from one. Yes, we can have great experiences after horrendous births, but I have wondered for the past 37 years if healing—real healing—is possible. I would really like to hear from you on this issue. I recently had a great conversation about this subject with a Facebook friend named Kelly Edwards Troyer. Here is what she had to say:

I went to a MT conference when my third baby was just a little baby and I was feeling called to midwifery. It was such a great experience. I know what you mean about healing though. For a while after my peaceful births, I mourned even more what I and my son lost during the cesarean, but ultimately I felt more healing. But, no, I wouldn't say I'm over it…does anyone ever get over their births, the good or the bad? I wonder about moms who claim to not feel anything about their births.

Regarding healing through VBACs, Kelly said, "When I was having mine, I realized the risk of having a uterine rupture was no higher than the risk of having any other major birth emergency at home, so I let that fear go. I want more clients/friends/mamas everywhere to be able to do the same thing and be blessed with as much beauty and healing as I was with mine." We are beginning to know through ongoing research that the baby internalizes these traumatic birth experiences. They last a lifetime. Most of us are probably walking around somewhat damaged by our own birth experience, because almost everyone born in Western countries has had a traumatic experience coming into the world. It is much better for everyone concerned, and society in general, if we all work toward optimal births for every motherbaby.

If you have healed, truly healed, from a negative birth experience, please let us know how you think that transpired. As for me, I know I never will, and use the energy and pain from my first birth to propel me to help every mother and baby possible avoid this damage.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Jan's blog: community.midwiferytoday.com/blogs/jan/default.aspx
Jan on Twitter: twitter.com/jantritten
Midwifery Today on Facebook: facebook.com/midwiferytoday


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Research

US Study Highlights Homebirth Safety

Chalk up another win for the safety of homebirth. A study of low-risk births in select US birth facilities published in the January 2010 issue of the American Journal of Obstetrics and Gynecology concludes that homebirths are "associated with a number of less frequent adverse perinatal outcomes" when compared to births that occurred in a hospital facility.

The study, which examined 745,690 low-risk births that occurred in various US facilities during the year 2006, compared the outcomes according to birth site: 97% of the births were in a hospital; 0.6% occurred in a birth center; and 0.9% were at home.

Homebirth babies in this study experienced more frequent 5-minute Apgar scores of less than 7 and researchers noted that "compared to hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors."

Researchers concluded that the home and birthing center births "were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and [low] birth weight."

— Wax JR, Pinette MG, Cartin A, et al. "Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births." Am J Obstet Gynecol 2010 202:152.e1-5


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Pathways Magazine provides vital resources for family wellness. Our articles give parents the necessary information to actively participate in their families' natural health choices. Geared towards new parenting, there are always articles on birth and pregnancy from the vitalistic, midwifery perspective. A must have for holistic education in your practice.

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Dr. Brewer’s Fight to Nourish Pregnant Women

Women who took Dr. [Tom] Brewer's advice and ate salt, took in plenty of protein and gained weight, remained healthy and birthed healthy babies. Those who tried to follow the advice of their doctors had trouble. In 7,000 births, Dr. Brewer saw no cases of convulsive toxemia in women who followed his program throughout her full pregnancy….

No woman was ever told by Dr. Brewer that she was gaining too much weight. She was only weighed to be sure she was gaining enough.

Sometimes they'll gain as much as 75 pounds, which is perfectly normal, Brewer said. But everyone else was doing the opposite. If a practitioner didn't worry about a woman's weight, he was considered an idiot.

Madison Avenue was promoting the thin look as Twiggy arrived from England. The ideal of thinness swept the American culture. According to Brewer, obstetrical doctors were overly concerned about swelling and weight gain. They combined diuretics with a low-calorie, low-salt diet for their patients. Some of the pregnant women were put on diets as low as 500 to 600 daily calories to hold their weight down and were restricted from using salt to control edema. Dr. Brewer declared this would spread toxemia across the entire country, and it did.

Once a disease of the poor and undernourished, toxemia has now become a disease of all classes. In fact, wherever the Western low-calorie, low-salt diet, weight control and the use of diuretics became popular, metabolic toxemia in late pregnancy (MTLP) appeared, and with increasing frequency among the upper classes.

Dr. Brewer's findings are corroborated by none other than the ancient Egyptians. He learned that the pharaohs' pregnant wives ate pigeon, duck, goose, fish, lentils, beef, pork, honey, kelp and bread. They also ate figs and dates and a variety of spices. Their babies were robust. However, the peasants had little of this fare; they consumed mostly beer and bread. At some point, the pharaoh's priest-physician began to restrict salt to the peasants.

"Locked in the pharaohs' tombs, five thousand years ago, [were] the 'secrets' of toxemia," Dr. Brewer stated. "Thanks to Jean-Francois Champollion, who cracked the code of the hieroglyphics in 1821, we find the first evidence of the eclamptogenic diet and the resulting problems associated with deprivation."

Nancy Wainer Cohen excerpted from an interview conducted by Renee Stein, CM
Excerpted from "An Uphill Battle: Dr. Brewer's Fight to Nourish Pregnant Women," Midwifery Today, Issue 40
View table of contents / Order the back issue


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Web Site Update

Read this editorial by Jan Tritten from the brand-new issue of Midwifery Today, Spring 2010:

  • The Miracle of Homebirth
    Homebirth is the gold standard, God's standard, the highest standard of Birth possible. The uplifting feeling a mom gets, having birthed in her own power, is unlike anything else in the world. There is incredible joy and love possible following God's design for birth as He created it. But it seems humans want to interfere, to tamper with the spirit involved in this natural process.

The table of contents for the brand new issue of Midwifery Today (Number 93, Spring 2010) is now online.

Read these reviews from Midwifery Today newly posted to our Web site:

Enter our short video contest on the theme "Birth Is a Human Rights Issue" and you could win a free five-day conference registration! Entry Deadline is August 10, 2010. Go here for more information and instructions.


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Question of the Week

Q: My daughter-in-law is pregnant and it's been discovered that she, like her sister, has a clotting disorder (their mom also has it). My midwife told me that she and her partner are seeing more and more pregnant women with clotting disorders whom they have to turn away, due to the fact that they are high risk. Is she alone in this? Or are midwives across the country finding more young women with clotting disorders? And anyone care to venture a guess as to why? Is it that screening is better or is it that there really are more women born with, or developing, clotting disorders throughout their life?

— Katie


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


Question of the Week Responses

Q: My son, my first child, was born early at 35 weeks and no one was ever able to tell me why. My labor was very fast once my water broke (2 hrs). He had to visit the NICU at the hospital for over a week due to respiratory and feeding issues. I want a homebirth this time around so badly. What natural methods can I do to increase my chances that I'll go to at least 37 weeks this time around? Thank you.

— Jill Klink

A: One thing that may help and shouldn't hurt is to increase your intake of the Omega-3 fatty acid DHA. A diet adequate in DHA has been shown to increase length of gestation, as well as help with fetal brain and retinal growth, reduce postpartum depression, and maybe prevent pre-eclampsia and low birth weight babies.

Current recommendations are 200–300mg/day of DHA, or two servings of Omega-3 rich fish a week. Oily cold-water fish like Alaskan wild salmon, herring, sardines, and anchovies are rich in DHA and also low in mercury (eat the skins, too). Another option is to take cod liver oil or fish oil supplement in the form of liquid oil or soft gel capsules. Be sure to read the label and look at the amount of Vitamin A to see that it's within a safe range for pregnancy (>20,000 IU/day can be harmful to the baby). Carlson's Cod Liver Oil, lemon-flavored, is my favorite and is safe in pregnancy. Nordic Naturals is another good brand.

Don't overdose on fish oil: very high doses may contribute to bleeding problems.

You may have read about flaxseeds, walnuts, and sesame seeds as being sources of fatty acids, but the body does not appear to convert this plant form into DHA. So while nuts are great to eat, they don't replace fish for this particular purpose.

DHA continues to be important for infant brain growth (and may be beneficial in preventing allergies, asthma, and eczema), so fish oils are important to continue while breastfeeding.

Hope this helps! Best wishes with your pregnancy, birth and baby.

— Kelly Sicoli, RN
Student at Frontier School of Midwifery & Family Nursing

A: I am not sure that I have an answer as such. In truth, I have more questions that I think maybe we should all be asking ourselves.

It is very hard indeed to answer such a question with so little information, especially if you say that "no one was ever able to tell me why." But who are these "no ones"? What do we know about your lifestyle, your work, the environment where you live, your levels of stress, the place where you receive attention and the outlook these people have on health care?

Maybe we don't know a lot yet about how to ensure that a pregnancy runs its course free of problems, and that babies are born at term and healthy. There are still lots of unknown factors. However, we do have increasing evidence that too much technology, too much exposure to a number of common pollutants, too much intervention, too many drugs, too many chemicals in our food and water—all have an impact in our health and that of our babies.

Which of those factors have you taken into consideration that perhaps may be changed for the better? Can you perhaps take it easier, relax more and give yourself more to the enjoyment of your pregnancy? Eat better, exercise more, move to a cleaner/quieter place? Can you be seen by health care professionals who care more about the holistic approach and less about the latest gadgets and exams? How about Faith? How willing are you to trust that your body/your baby/nature/God knows what they're doing, and to accept things as they come—for better or worse?

Maybe none of these things will make one whit of difference. Maybe you already are a calm, meditating, yoga-practicing health nut who lives in the mountains and are seen only by the wisest natural practitioners and midwives…But, nevertheless, I think that whenever we wish for a change, our life and habits bear some examination.

Blessings and much success,

— Alejandro Araujo
Prenatal educator, birth facilitator, breastfeeding consultant

A: I am a doula and had a client who had three children all born before 35 weeks. Pregnant with her fourth baby, our goal was to keep her pregnant until at least 37 weeks this time. She saw a chiropractor, drank a minimum of one gallon of water every day, and ate a diet high in protien (about 100 grams a day). She gave birth at 37 weeks and one day!

— Tonya C. Buffington
http://www.righthanddoula.com

A: My first birth was at 35 weeks. My water broke and because they induced me to move me along within the 24-hour window, there ended up being fetal distress and a c-section. Second time around, my water broke at 34 weeks. I had asked my OB for a bacterial vaginosis test and he refused, saying I needed a progesterone shot to prevent pre-term labor. I insisted I wasn't in labor when my water broke. When I entered the hospital I was given 24 hours to labor or he could go ahead and do the surgery. I buckled under his pressure and had the surgery.

Fast forward two years later. I was again pregnant and this time determined it would not be like the previous pregnancies and births. I found a midwife who tested me for bacterial vaginosis and I was positive. We started antibiotics and natural things as well. I delivered at 40 weeks and 2 days!

I also ate a lot of garlic, and took a lot of vitamin C (which is supposed to strengthen the bag of water).

Hope that helps!

— Mandi Barnett

A: Nutrition, nutrition, nutrition. Start before you're pregnant!

It depends on your health/weight/who you are, but I generally recommend:

Drink water—1/2 your body weight in ounces daily; take a pregnancy infusion (http://gentlebirths.net/17/herbal-pregnancy-blend/); and make sure you're getting bioflavonoid, easily digestible protein, raw/cooked greens, moderate whole grains, and some dairy and eggs into your diet.

Be well,

— Carol Gautschi, CPM, LM
Washington Alliance of Rural Midwives
Peninsula Birth Matters
http://gentlebirths.net

A: I had a similar experience with my second son, who was born at home at 35-1/2 weeks, very fast (about 1 hour from the time I woke up from a nap, unaware of my labor). He did not have any respiratory or other problems. My next birth, however, was a 32-week intrauterine fetal demise, no official medical explanation, even though my midwives had me deliver at a medical research hospital, where everyone tried to figure out what had happened. I had a trace of blood and a trace of protein in my urine at a routine midwife visit 1-1/2 weeks before, but the protein was attributed to the blood, and my blood pressure really didn't seem to be very raised. I had some swelling, just as I'd had in all my pregnancies. I saw many doctors and practitioners afterward, and all were in agreement that I was not considered high risk.

In my last pregnancy, also a planned homebirth, I developed the same trace of blood/trace of protein at 34-1/2 weeks, despite my having done everything nutritionally possible (beginning more than two years in advance) and everything else my midwives, naturopath, acupuncturist, dentist, and medical doctor knew to do for a healthy pregnancy. My midwife immediately had me do a 24-hour urine test, which showed very elevated protein levels, unlike the in-office dip. Even though I had absolutely no swelling this time, felt well, and my blood pressure was elevated but not alarming, she had me tested at the hospital the very day my labs came back because of my prior history. The ultrasound showed baby and placenta were fine. I was told I had "mild pre-eclampsia" and was sent home and told to take it easy and try to keep the stress down, but not put on bed rest.

My midwives and the perinatologists co-cared, and the following week I went in for a second ultrasound, which showed the placental blood flow was greatly reduced. My husband and I were shocked at the difference from the previous week. My baby was born later that day by c-section, after my midwife reviewed everything, consulted with the medical staff, and sat with me while the baby's heart rate dipped horribly during an induction. I asked her what she thought about going forward with the induction vs. asking for a c-section, and she said, "I rarely ever recommend a c-section, but in your case, I feel it is justified." I am very grateful for those words, even if they may not have been true; they softened the blow of having a surgical delivery. She held my hand in the operating room and was my advocate from start to finish. Baby was even smaller than expected, only 3 lb 12 oz, and spent 10 days in the NICU, but she is fine.

I don't mean to scare anybody or to encourage c-section. I know about the "cascade of interventions." I also know now that I wasn't low risk after all. I was and am a homebirth advocate. But I wanted to share that I had a similar unexplained early/fast labor like you described, and it seemed okay at the time, only to be followed by much less happy pregnancies and births. If I hope to do anything by sharing this, it is to encourage you to be very, very careful about nutrition and health before and during your next pregnancy(ies), and to be sure your midwife is aware of the potential for this odd route to pre-eclampsia/fetal demise and/or IUGR (and has a good back-up in place), so she can help you avoid any problems, if possible, and react quickly to help you if you develop a complication. I believe the combination of my midwife team's carefulness and awareness and my preparations and extreme good health is responsible for the difference between my stillbirth and my complicated but, in the end, live birth and healthy baby.

I really hope all goes well for you, and I am just an anomaly. But after my stillbirth, I wished someone would have told me that my early/fast labor with my son might be a warning sign of things to come which would require extra-special attention and care.

Warmly,

— Gayla Jeppesen
Portland, Oregon


Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


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Dear Midwifery Today,

The Baltimore, Maryland, chapter of the International Cesarean Awareness Network (ICAN) is seeking submissions for an art exhibit titled, "Cesarean Voices." The exhibit will be the first of its kind in the country and will be an exploration of the issues surrounding cesarean birth. It would also serve to help educate the public to the reality that cesareans can have profoundly negative physical and emotional consequences for women and those close to them. Our goal is to hold the exhibit in Baltimore beginning with an opening reception to include the public, medical community and the media. After the initial run in Baltimore, the installation will become available for other birth organizations nationwide to use in their communities as an educational tool. We are accepting submissions for artwork to be shown in an ongoing installation to include original paintings, drawings, computer generated art, belly casts, poetry, and tapestries. Artwork must translate to the public the experience of having a cesarean either through your own or someone else's eyes. The six guidelines can be found at http://www.icanofbaltimore.org/site/. The deadline for submissions is April 7, 2010. Please contact tiffanyaverill@hotmail.com if you are interested in submitting artwork or have any questions. Also plan to include a brief explanation about your piece.

Barbara Stratton
ICAN of Baltimore


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